93: Digital Ray Amputation

Published on 18/04/2015 by admin

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Last modified 18/04/2015

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Procedure 93 Digital Ray Amputation

Pao-Yuan Lin, Sandeep J. Sebastin, Kevin C. Chung

imageSee Video 69: Digital Ray Amputation

Indications

image Traumatic amputation close to the metacarpophalangeal (MCP) joint that leaves a gap in the hand

image Elective procedure in patients with a functionally impaired digit

image Treatment of infection, failure of replantation, vascular disorder, or tumor

Examination/Imaging

Clinical Examination

image In patients undergoing ray amputation for a painful stump, the point of maximal tenderness due to a neuroma (if any) should be identified preoperatively and marked. Figure 93-1 shows a patient with a painful stump.

image

FIGURE 93-1

Imaging

image Radiographs of the hand (Fig. 93-2).

image

FIGURE 93-2

Surgical Anatomy

image The deep transverse metacarpal ligament connects the volar plates of the MCP joints of the index, long, ring, and small fingers. The flexor tendons, neurovascular bundles, and lumbrical tendon pass palmar to the deep transverse MCP ligament, whereas the interosseous tendon lies dorsal to it (Fig. 93-3).

image

FIGURE 93-3

Positioning

image The procedure is performed under tourniquet control. It can be done under regional or general anesthesia. The patient is positioned supine with the affected extremity on a hand table.

Exposures

image A racket-shaped incision is marked around the base of the finger. On the dorsum, this incision extends over the proximal metacarpal in a longitudinal fashion (Fig. 93-4A). On the palmar aspect, it is designed as a V (Fig. 93-4B).

image

FIGURE 93-4

Pearls

The incision is made on the finger that is going to be amputated and not into the web. This allows a good repair of the web space after the ray amputation.

Procedure

Step 1

image The extensor digitorum communis (EDC) tendon is identified on the dorsum, divided at mid-metacarpal shaft, and raised as a distally based tendon (Fig. 93-5). The juncturae to the adjacent fingers are also divided.

image

FIGURE 93-5

Step 1 Pearls

The extensor indicis proprius (EIP) or the extensor digiti quinti minimi (EDQM) tendons will have to be divided at the same level as the EDC when a ray amputation of the index or small finger is being carried out.

Step 2

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